CROI 2015 Program and Abstracts

Abstract Listing

Poster Abstracts

Table 1. Characteristics of the population. *Social use considered using alcohol on weekends or less frequently; LTFU, lost to follow up; SD, standard deviation; ARV, antiretrovirals; MPR, medication position ratio Conclusions: Overall, linkage to the down-referral site was high. Patient dissatisfaction with clinic and poor adherence were independently predictive of failure to re-link to care upon down-referral but VF was not. In a country with over 2 million on ART, even a small percentage failing down-referral may be problematic and it will be important to identify those at high risk of loss to follow up. 1075 Retention in a Decentralized HIV Care and Treatment Program in North Central Nigeria Patricia Agaba 1 ; Becky L. Genberg 2 ; Solomon Sagay 1 ; Oche Agbaji 1 ; Nancin Dadem 3 ; Grace Kolawole 3 ; Prosper Okonkwo 3 ; Seema Meloni 4 ; Phyllis Kanki 4 ; Norma C.Ware 5 1 University of Jos, Jos, Nigeria; 2 Brown University, Providence, RI, US; 3 AIDS Prevention Initiative, Abuja, Nigeria; 4 Harvard School of Public Health, Boston, MA, US; 5 Harvard Medical School, Boston, MA, US Background: Rapid expansion of antiretroviral therapy (ART) in Africa has improved outcomes for HIV/AIDS, with decentralization as a key strategy for improving treatment access. Decentralization refers to expansion of ART delivery from tertiary to secondary and primary health care (satellite sites). We describe the retention of adult patients in a “hub-and-spoke” decentralization model in north central Nigeria. Methods: Data from clinical records between 2008-2012 were used to examine retention using two measures. Retention was defined as: 1) gaps between visits of <180 days, and 2) visit constancy (cumulative proportion of 6-month intervals with at least one clinical visit). Standard descriptive statistics were used to describe the sample and examine differences between tertiary and decentralized sites. Logistic regression analysis with generalized estimating equations was used to estimate the effect of decentralization on gaps and visit constancy (>80% vs. <80% periods with >1 visit), while controlling for patient age, sex, WHO stage and previous ART at baseline. Results: There were 18,158 patients with 54% enrolled at the tertiary site. The median age of the cohort was 37 years and 66%were female. Thirty-five percent were in WHO stages 3 or 4 and 9% had previous ART experience at baseline. The median time in care was 567 days. Overall, 7.1% of visits were >180 days apart, with the tertiary site having a higher proportion of gaps compared to satellite sites (9.5% vs 4.3%, p<0.0001), while the satellites had a higher frequency of periods with at least one visit compared to the tertiary site (95.1% vs 93.2%, p<0.0001). In adjusted analysis enrollment at the tertiary site (OR = 3.73, 95% CI: 3.46-4.02), and previous ART experience (OR=1.17, 95% CI: 1.06- 1.29) were associated with gaps in care. Patients at the tertiary site were also 2 times more likely to have <80% of periods without a clinical visit (OR=2.05, 95% CI: 1.78-2.37). Conclusions: With the hub-and-spoke model of decentralization, retention at satellite sites was better than at the tertiary care site. Patients in decentralized sites had fewer gaps between visits and were more likely to maintain constancy of care over time. Further research is needed to understand the barriers to optimal retention at the tertiary site in order to achieve care objectives. 1076 Patient Level Findings: Pre-ART Mortality and Its Determinants in Tanzania Public-Driven HIV Care Program (2004-2011) Bonita K. Kilama 1 ; Candida Moshiro 2 ; JimTodd 4 ; Angela Ramadhani 1 ; Donan Mmbando 3 1 National AIDS Control Program, Dar es Salaam, United Republic of Tanzania; 2 Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania; 3 Ministry of Health Of Social Welfare, Dar es Salaam, United Republic of Tanzania; 4 London School of Hygiene and Tropical Medicine, London, United Kingdom Background: Limited information is available on patients prior to the start of anti-retroviral therapy (ART), as monitoring of HIV care services has mainly focused on ART initiation and subsequent patient survival. Tanzania has unique data from the national care and treatment clinic (CTC) program for pre-ART HIV positive clients. This analysis reports mortality and determinants of mortality among HIV infected adults prior to ART initiation. Methods: A retrospective cohort of HIV infected adults (aged 15 years or more) enrolled in Tanzanian CTC prior to ART initiation from November 2004 to December 2011. Patient characteristics at the time of enrolment were described and time from CTC enrolment to death prior to ART initiation used to estimate mortality rates and 95% confidence intervals (95% CI) from Cox proportional hazards regression models. Adjusted Hazard Ratios (AHR) were obtained after adjustment for age, sex, WHO stage CD4 counts, BMI, TB screening and functional status at enrolment.

Poster Abstracts

628

CROI 2015